Standards of Pharmacy Operations Templates & Forms

• Sample CDSA Purchase Register
• Template Monthly Random Audit of CDSA Purchase Records
• Template Monthly Random Audit of CDSA Sales Records
• Template Medication Incident Form

Standards of Practice Templates & Forms

• Template Documentation of Pharmacist-Authorized Exempted Codeine Product Requests Form-Initial Sale
• Template Documentation of Pharmacist-Authorized Exempted Codeine Product Requests Form-Repeat Sale
• Template Administration of Drug Therapy by Inhalation or Injection Documentation & Notification Form
• Template Personal Care Home Medication Safety Audit Form
• Template Personal Care Home Medication Storage Audit Form
• Template Personal Care Home Medication Returns Form

Non-Sterile Compounding Resources

• Frequently-Asked Questions About Compounding
• Diagram 1-Decision Algorithm for Risk Assessment
  • Sample Risk Assessment-Diclofenac
  • Sample Risk Assessment-Hydrocortisone 1% / Ketoconazole 2% 1:1 cream
• Table 1-Elements to Cover in Training-Compounding Personnel
• Table 2-Elements to Cover in Training-Cleaning Personnel
• Table 3-Examples of Policies and Procedures
• Table 6-Example Components OF a Quality Assurance Program
• Checklist 1-Skills Assessment Checklist
• Template 1-Developing a Procedure
• Template 2- Master Formulation Record
• Template 3-Incident-Accident Reporting Form

Health Canada Resources

• Controlled Substances Guidance for Community Pharmacists: Security, Inventory Reconciliation and Record-Keeping
• Guidance Document – Handling and Destruction of Post-Consumer Returns Containing Narcotics, Controlled Drugs or Targeted Substances
  • Template – Record of Local Destruction of Post-Consumer Returns Containing Narcotics, Controlled Drugs or Targeted Substances
  • Health Canada Controlled Substances Bulletin – Post-Consumer Returns During the COVID-19 Pandemic
• Guidance Document – Handling and Destruction of Unserviceable Stock Containing Narcotics, Controlled Drugs or Targeted Substances
  • Template – Record of Local Destruction of Unserviceable Stock Containing Narcotics, Controlled Drugs or Targeted Substances
• Reporting Loss or Theft of Controlled Substances and Precursors
• Health Canada Loss or Theft Report Form for Controlled Substances and Precursors – Please be sure to send a copy to both Health Canada and the NLPB, as well as retaining a copy in your pharmacy.
• PLEASE NOTE: In accordance with Health Canada’s Guidance Documents, forged prescriptions are only considered thefts if a drug product containing a controlled substance or a precursor is actually dispensed, either partially or fully. The dispensed amount should be reported as the quantity stolen. Attempted forgeries where no drug products were dispensed are not to be reported.

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